Application for use of Courthouse/Grounds
Pike County Board of Commissioners
Contact
*
Responsible Person
Street Address
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Event Time
*
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Group requesting use:
*
Name of event:
*
Type of event:
*
Specific areas of use: (grounds, porch, bldg.)
*
Open to general public? (Yes or No)
*
Number expected?
*
Equipment to be used on grounds (chairs, tables, electrical, etc.)
*
When will equipment be setup/taken down?
*
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Will food be served? (yes or no)
*
For a fee? (yes or no)
Has this group used Courthouse/Grounds for other events? (yes or no)
*
Were any problems encountered?
What dates and/or problems?
Signature of Responsible Party
*
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preview PDF
Submit
Should be Empty: